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- Original article Development and validation of the Health Literacy Index for the Community (HLIC) for the Korean National Health and Nutrition and Examination Survey
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Junghee Yoon1,2
, Soo Jin Kang3
, Mangyeong Lee4
, Juhee Cho1,5
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Epidemiol Health 2024;e2024061
DOI: https://doi.org/10.4178/epih.e2024061 [Accepted]
Published online: July 10, 2024
2Patient-Centered Outcomes Research Institute, Samsung Medical Center, Seoul, Korea
3Department of Nursing, Daegu University, Daegu , Korea
4Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
5Cancer Education Center, Samsung Medical Center, Seoul, Korea
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Corresponding author:
Juhee Cho,
Email: jcho@skku.edu
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Abstract
OBJECTIVES
We developed and validated the Health Literacy Index for the Community (HLIC) to assess the health literacy of the Korean population within the framework of the Korean National Health and Nutrition and Examination Survey.
METHODS
The HLIC was developed through 1) defining the conceptual framework and generating the item pool and 2) finalizing the items and identifying the cutoff value. Interviews were conducted to examine items' face validity, and a cross-sectional survey was performed to analyze the item-response theory and Rasch models to investigate the instrument's psychometric properties.
RESULTS
In this study of 1,041 participants, most had no difficulty understanding health information; however, 67.9% struggled to assess the reliability of health information from the internet or media. A 4-factor structure was identified through factor analysis, leading to the exclusion of some items. This resulted in 10 items across 4 domains: 1) disease prevention, 2) health promotion, 3) health care, and 4) technology and resources. The HLIC demonstrated good internal consistency, with a Cronbach's ɑ of 0.87. It also showed high test-retest reliability and correlations with other health literacy instruments. A sociodemographic analysis of the HLIC revealed disparities in health literacy across various age groups, education levels, and income brackets.
CONCLUSIONS
The HLIC was developed to systematically measure health literacy in Korea's general population. Its simplicity and conciseness ensure reliability and validity and improve its accessibility, making it particularly suitable for the broader Korean population, including those with lower literacy levels.
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